Common Contracts
2 similar Therapist-Patient Services Agreement contracts
THERAPIST-PATIENT SERVICES AGREEMENTTherapist-Patient Services Agreement • June 15th, 2017
Welcome to my practice. This document contains information about our professional services and business policies. It also contains summary information about the Health Insurance Portability and Accountability Act (HIPAA), a federal law that provides privacy protections and rights for you as a patient with regards to the use and disclosure of your Protected Health Information (PHI). HIPAA requires that we provide you with a Notice of Privacy Practices (The Notice) for the use and disclosure of PHI, for treatment, payment, and health care operations. The Notice, explains HIPAA and its application to your personal health information in greater detail. The law requires that we obtain your signature acknowledging that we have provided you with this information before the end of today’s session.
THERAPIST-PATIENT SERVICES AGREEMENTTherapist-Patient Services Agreement • November 30th, 2014
Welcome to my practice. This document contains information about our professional services and business policies. It also contains summary information about the Health Insurance Portability and Accountability Act (HIPAA), a federal law that provides privacy protections and rights for you as a patient with regards to the use and disclosure of your Protected Health Information (PHI). HIPAA requires that we provide you with a Notice of Privacy Practices (The Notice) for the use and disclosure of PHI, for treatment, payment, and health care operations.
